Potential for repurposing oral hypertension/diabetes drugs to decrease asthma risk in obesity

Abstract

Objective

Risk for asthma in the overweight/obese may be mediated by adiponectin and peroxisome proliferator activated receptor pathways and may be reduced by the use of oral drugs impacting these pathways, such as angiotensin converting enzyme inhibitors (ACE-I), thiazolidinediones (TZD), and angiotensin receptor blockers (ARB). Our study objective was to determine whether ACE-I, TZD, and/or ARB use in overweight/obese adults with diabetes mellitus and/or hypertension is associated with a lower risk for incident asthma.

Methods

Using an existing cohort of American veterans, we performed a longitudinal data analysis over 15 years. Exposure was defined by the prescription pickup of ACE-I, TZD, and/or ARB for at least 4 weeks. The outcome, time until new-onset of clinician-diagnosed asthma, was studied using survival analysis. The propensity scoring method controlled for treatment selection bias.

Results

2.83 million eligible veterans, including 77,278 with incident asthma, were studied. As compared to those unexposed, the use of ACE-I alone, TZD alone, or their combinations were each associated with decreased risk for incident asthma (hazard ratios of 0.88, 0.74, and 0.20, respectively; p < 0.001 for all analyses in the fully adjusted statistical models). TZD lowered the risk among racial/ethnic minority subjects more than among White participants (p < 0.001). On the other hand, ARB use alone or in combination with TZD was associated with a higher risk for incident asthma.

Conclusions

Use of ACE-I and/or TZD was associated with a lower risk for incident asthma in overweight/obese patients with diabetes mellitus and/or hypertension.

Keywords:

• Angiotensin converting enzyme inhibitor
• angiotensin receptor blocker
• thiazolidinediones
• incident asthma
• adiponectin
• peroxisome proliferator-activated receptor

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the United States Agency for Health Care Research and Quality under grant number R01 HS 023093–01. The sponsor was not involved in study design; collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.